Tobacco and Cancer: Recent Epidemiological Evidence
The authors are grateful to Jerry Rice, Paolo Boffetta, Paul Brennan, and all
the staff of the IARC Unit of Carcinogen Evaluation and Identification for
support.
Manuscript received March
Tobacco and Cancer: Recent Epidemiological Evidence
P. Vineis 0 1
M. Alavanja 0 1
P. Buffler 0 1
E. Fontham 0 1
S. Franceschi 0 1
Y. T. Gao 0 1
P. C. Gupta 0 1
A. Hackshaw 0 1
E. Matos 0 1
J. Samet 0 1
F. Sitas 0 1
J. Smith 0 1
L. Stayner 0 1
K. Straif 0 1
M. J. Thun 0 1
H. E. Wichmann 0 1
A. H. Wu 0 1
D. Zaridze 0 1
R. Peto 0 1
R. Doll 0 1
0 DOI: 10.1093/jnci/djh014 Journal of the National Cancer Institute , Vol. 96, No. 2, © Oxford University Press 2004, all rights reserved
1 Affiliations of authors: Unit of Cancer Epidemiology, University of Torino, CPO-Piemonte , via Santena 7 10126 Torino, and ISI Foundation, Torino , Italy ( PV); Division of Cancer Epidemiology, National Cancer Institute, National Institutes of Health , Bethesda, MD (MA); School of Public Health, University of California , Berkeley, CA (PB , J. Smith); Department of Public Health and Preventive Medicine, Louisiana State University, New Orleans (EF); International Agency for Research on Cancer , Lyon, France (SF , KS); Department of Epidemiology, Shangai Cancer Institute , Shangai , China ( YTG); Tata Institute of Fundamental Research , Mumbai , India ( PCG); Cancer Trials Centre, University College London, UK (AH); Instituto de Oncologia, Universidad de Buenos Aires , Buenos Aires , Argentina ( EM); Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health , Baltimore, MD (J. Samet); National Health Laboratory Service , Johannesburg , South Africa ( FS); UIC School of Public Health, Chicago IL (LS); American Cancer Society, Atlanta, GA (MJT); GSF-Institute of Epidemiology , Neuherberg , Germany ( HEW); University of Southern California, Los Angeles (AHW); Institute of Carcinogenesis, Academy of Medical Sciences , Moscow , Russia ( DZ); Clinical Trial Service Unit and Epidemiolocal Studies Unit, University of Oxford , UK (RP, RD). versity of Torino - CPO - Piemonte, via Santena 7 10126 Torino , Italy
During the 1950s, the evidence was clearly sufficient to establish the carcinogenicity of tobacco smoking (1). By the end of the 1950s, convincing evidence linking smoking with lung cancer and other cancers had been obtained from case- control and cohort studies, carcinogens had been identified in tobacco smoke, and cigarette smoke condensate had been shown to cause tumors when painted on the skin of mice. Since then, the numbers of deaths attributable to tobacco smoking have sharply increased, reflecting the heavy smoking patterns of previous decades. It has been estimated that tobacco smoking is currently responsible for approximately 30% of all cancer deaths in developed countries, and that if current smoking patterns persist, an epidemic of cancer attributable to tobacco smoking is expected to occur in developing countries (2). In addition, smoking causes even more deaths from vascular, respiratory, and other diseases than from cancer, so that, in total, tobacco smoking is estimated to account for approximately 4 -5 million deaths a year worldwide. This number is projected to increase to approximately 10 million a year by 2030. Thus, if current smoking patterns continue, there will be more than 1 billion deaths attributable to tobacco smoking in the 21st century compared with approximately 100 million deaths in the 20th century (2). The only other causes of disease with such rapidly increasing impact are those associated with human immunodeficiency virus infection and, perhaps, obesity in Western countries (2). In this commentary, we review the evidence regarding the carcinogenicity of tobacco smoke that has accumulated during the last 16 years since the publication of Monograph 38 of the International Agency for Research on Cancer (IARC) in 1986 (3) to the updating of that monograph (Monograph 83) in 2002 (4). The evidence now available shows that tobacco smoke is a multipotent carcinogenic mixture that can cause cancer in many different organs. In addition, exposure to secondhand tobacco smoke (i.e., involuntary or passive smoking by persons who do not smoke) is also carcinogenic for the human lung. This commentary, written by the epidemiologists who participated in the 2002 IARC Working Group for the preparation of the IARC Monograph 83 (4), is based on the substantial body of evidence reviewed for that purpose. It represents, however, solely the views of the authors.
TOBACCO SMOKE is a MULTIPLE ORGAN SITE
CARCINOGEN
In 1986, the IARC Working Group (
3
) found that there was
sufficient evidence that active tobacco smoking was
carcinogenic in humans, and concluded that tobacco smoking caused
cancers not only of the lung, but also of the lower urinary tract
including the renal pelvis and bladder; upper aero-digestive tract
including oral cavity, pharynx, larynx, and esophagus; and
pancreas. The assessment of the (...truncated)